<!DOCTYPE html>
<html>
  <head>
    <title>Place Autocomplete Address Form</title>
    <style>
      html, body, #map-canvas {
        height: 100%;
        margin: 0px;
        padding: 0px
      }
    </style>
    <script src="https://maps.googleapis.com/maps/api/js?v=3.exp&sensor=false&libraries=places"></script>
    <script>

var placeSearch, autocomplete;
var componentForm = {
  street_number: 'short_name',
  route: 'long_name',
  locality: 'long_name',
  administrative_area_level_1: 'short_name',
  country: 'long_name',
  postal_code: 'short_name'
};

function initialize() {
  autocomplete = new google.maps.places.Autocomplete(
      (document.getElementById('autocomplete')),
      { types: ['geocode'] });
  google.maps.event.addListener(autocomplete, 'place_changed', function() {
    fillInAddress();
  });
}

function fillInAddress() {
  var place = autocomplete.getPlace();
  for (var component in componentForm) {
    document.getElementById(component).value = '';
    document.getElementById(component).disabled = false;
  }

  for (var i = 0; i < place.address_components.length; i++) {
    var addressType = place.address_components[i].types[0];
    if (componentForm[addressType]) {
      var val = place.address_components[i][componentForm[addressType]];
      document.getElementById(addressType).value = val;
    }
  }
}

function geolocate() {
  if (navigator.geolocation) {
	    navigator.geolocation.getCurrentPosition(function(position) {
      var geolocation = new google.maps.LatLng(position.coords.latitude, position.coords.longitude);
      autocomplete.setBounds(new google.maps.LatLngBounds(geolocation, geolocation));
    });
  }
}
</script>

</head>

<body onload="initialize()">
    <div id="locationField">
      <input id="autocomplete" placeholder="Enter your address" onFocus="geolocate()" type="text"></input>
    </div>
    <table id="address">
      <tr>
        <td class="label">Street address</td>
        <td class="slimField"><input class="field" id="street_number" disabled="true"></input></td>
        <td class="wideField" colspan="2"><input class="field" id="route" disabled="true"></input></td>
      </tr>
      <tr>
        <td class="label">City</td>
        <td class="wideField" colspan="3"><input class="field" id="locality" disabled="true"></input></td>
      </tr>
      <tr>
        <td class="label">State</td>
        <td class="slimField"><input class="field" id="administrative_area_level_1" disabled="true"></input></td>
        <td class="label">Zip code</td>
        <td class="wideField"><input class="field" id="postal_code" disabled="true"></input></td>
      </tr>
      <tr>
        <td class="label">Country</td>
        <td class="wideField" colspan="3"><input class="field" id="country" disabled="true"></input></td>
      </tr>
    </table>
  </body>
</html>